203例农村有偿献血感染人类免疫缺陷病毒者的神经认知及社会生活功能

摘要

目的:调查通过献血途径感染人类免疫缺陷病毒(Human immunodeficiency virus,HIV)的203例患者的神经认知状况和社会生活功能.方法:横断面研究,采用神经心理成套测验和日常生活能力量表对安徽阜阳203例通过献血途径感染HIV的患者进行调查,选取198例年龄、性别和受教育年限相匹配的HIV阴性献血者为对照.神经心理成套测验包括执行功能、词语流畅、学习、记忆、精细运动、信息处理速度和工作记忆7个认知领域.以总体缺陷分≥0.5分作为认知损害的划界分.结果:HIV阳性受试总体认知功能[(45.7±5.9) vs.(49.4±6.0),P<0.01]和7个认知领域都较HIV阴性受试差.在精细运动功能方面HIV与丙型肝炎病毒(Heptitis C virus,HCV)感染存在交互作用(F=5.28,P<0.05).临床无症状期的HIV感染者和获得性免疫缺陷综合征(Acquired Immune Deficiency Syndrome,AIDS)患者认知损害率分别为29.2%和43.0%.HIV阳性受试的日常生活能力下降得分高于HIV阴性受试[(0.49±1.32 vs.(0.14±0.75),P<0.01],工作月数、个人和家庭月收入少于HIV阴性受试(P<0.01).认知损害组患者最低CD4细胞计数低于非认知损害组[(214.3±144.0) vs.(274.8±161.1),P=0.010],日常生活能力下降更明显[(0.75±1.58)vs.(0.34±1.13,) P<0.01].总体认知功能和日常生活能力下降相关(r=-0.22,P<0.01).结论:HIV感染者7个神经认知领域均有损害,合并丙型肝炎病毒感染可加重精细运动功能损害,随着疾病进展认知损害率提高;HIV感染者日常生活能力下降、职业功能和经济收入更差.最低CD4细胞计数对神经认知功能受损有一定预测作用;神经认知功能对日常生活能力下降造成一定影响,进而影响个人和家庭的经济收入.%Objective：To investigate the neurocognition and function of social life among human immunodeficiency virus (HIV) positive subjects infected by plasma donation.Methods:Totally 203 HIV positive subjects infected by plasma donation were recruited.Neuropsychological (NP) battery tests including executive function,verbal fluency,learning,memory,fine motor skill,speed of information processing and working memory domains were performanced among these subjects,as well as the Activity of Daily Living Scale (ADLs).And 198 HIV negative plasma donors were matched in gender,age and years of schooling.The cut-off of Global Deficit Score (GDS) was 0.5.Results：The HIV positive subjects performanced worse in global cognitive function [(45.7±5.9 vs.(49.4±6.0),P<0.01]and 7 cognitive domains than those of HIV negative subjects.HIV and HCV infection interacted on aspect of fine motor skill (F=5.28,P<0.05).The impairment rate of the subjects in asymptomatic stage and AIDS were 29.2% and 43.0% respectively.The HIV positive subjects showed more decline of ADLs scores than that of HIV negative subjects [(0.49±1.32) vs.(0.14±0.75),P<0.01].Working months,individual and family's income of HIV positive subjects were also less than that of HIV negative subjects(P<0.01).The lowest CD4 count in NP-impaired group was lower than that in non-impaired group [(214.3±144.0) vs.(274.8±161.1),P=0.01].Subjects with NP impairment reported more decline of ADLs scores [(0.75±1.58) vs.(0.34±1.13),P<0.01] than those without NP impairment.The global cognitive function scores were correlated with decline of ADLs scores (r=-0.22,P<0.01).Conclusion：HIV positive subjects are impairment on aspect of 7 cognitive domains,and co-infection of HCV can lead to more fine motor skill impairment.The more progression of disease,the higher NP impairment ratio.HIV infected subjects show decline of ADL,poorer occupational function and economical status.The lowest CD4 count may be a predictor to NP impairment.NP impairment is a factor which influenced the activity of daily living and the income of individual and family.